Fascitis necrosante en un niño. Evolución y tratamiento / Necrotizing fasciitis in a child. Evolution and treatment

La fascitis necrosante es una grave infección de progresión rápida y fulminante. Debe ser sospechada ante la progresión de lesiones dérmicas con necrosis de tejidos y afectación del estado general. En los niños no requiere una situación de inmunodepresión ni enfermedad de base. El tratamiento de elección es el abordaje quirúrgico precoz con desbridamiento amplio de la zona afectada. La situación funcional tras el tratamiento puede verse mermada. Presentamos un caso de fascitis necrosante en un niño, su evolución, el tratamiento y el abordaje rehabilitador tras la cirugía (AU)

Necrotizing fasciitis is a serious bacterial infection with rapid progression and fulminant course. It should be suspected in patients with rapidly progressing skin lesions with soft tissue necrosis and deterioration of general health status. This infection can occur in children without immunodepression or underlying diseases. The treatment of choice is wide surgical debridement of dead tissue. Functional recovery after treatment may be limited. We report a case of necrotizing fasciitis in a boy and his outcome, as well as the treatment of this infection and the approach to rehabilitation after surgery (AU)

Resultado a largo plazo en lesión de plexo lumbar / Long-term results in lumbar plexus injury

Las fracturas del sacro y del anillo pélvico son causa de lesión del plexo lumbosacro. El hematoma resultante tras la fractura o la propia fractura ocasionan daño de las estructuras nerviosas a nivel retroperitoneal. Tradicionalmente, este tipo de lesiones nerviosas han sido tratadas de forma conservadora, con un resultado final insatisfactorio en muchos casos por déficit parcial o total de la función de la extremidad inferior. Presentamos el caso de un varón de 37 años de edad que en enero de 2009 sufre un accidente de moto con traumatismo abdominal, fractura inestable de pelvis e importante hematoma retroperitoneal. El paciente tenía pérdida de función del nervio femoral y del obturador, así como de la musculatura dependiente del nervio ciáticopoplíteo externo. A los 8 meses se realiza exploración nerviosa del plexo lumbar, llevándose a cabo neurolisis del mismo. A los 5 años, el paciente ha recuperado la función de la musculatura del cuádriceps, que con una férula antiequino del pie le permite llevar una vida independiente y mantener su puesto de trabajo (AU)

Pelvic and sacral fractures are a potentially cause oflumbosacral plexus injury. Haematoma resulting due tobone fracture or bone disruption itself can compromise the nerves at the retroperitoneal level. Traditionally, neurological injuries have been treated conservatively, resulting in a motor function deficit in the lower limb. We present the case of a 37 year old man with pelvic and sacral fractures in a motorcycle accident. He suffered from a palsy of the femoral nerve, obturator nerve and peroneal nerve. Eight months later he underwent surgery performing neurolysis of the lumbar plexus. After 5 year she experienced quadriceps innervations, and with the assistance of a foot-drop splint, the patient ambulates well and is able to work in the same job he had before (AU)

Knee lymphocutaneous fistula secondary to knee arthroplasty.

Lower limb lymphorrhea secondary to a surgical procedure is a rare but difficult-to-solve complication. In lower limb, this entity is frequently associated with vascular procedures around the inguinal area. We report on a case of a knee lymphocutaneous fistula secondary to a knee revision arthroplasty. To our knowledge, no previous reports regarding this complication have been published.

Doppler ultrasonographic and scintigraphic assessment of an auxiliary heterotopic liver transplantation with portal vein arterialization in pigs.

OBJECTIVE: Our aim was to evaluate liver graft integrity and function using scintigraphy and ultrasonography in a porcine model of auxiliary heterotopic liver transplantation with portal vein arterialization (AHLT-PVA). MATERIALS AND METHODS: Using Doppler ultrasonography we evaluated eight AHLT-PVA by parenchymal echogenicity, portal and arterial anatomy, and portal and biliary system flow. Two types of scintigraphy were performed: microaggregated human albumin colloid scintigraphy and diisopropyl iminodiacetic acid (DISIDA) scintigraphy, both labeled with 99mTc. RESULTS: The animals were distributed into two groups. The first group consisted of three animals with clinical suspicion of graft dysfunction, in which the ultrasonographic study revealed areas of parenchymal destructuring. In the scintigraphic study, heterogenous uptake was observed; there was no uptake in one animal. Necropsy of these three animals revealed areas of graft necrosis. The second group consisted of five animals with good clinical evolutions, in which the ultrasonographic study showed portal dilation, portal flow with arterial spiculations, and homogenous echogenicity of the hepatic parenchyma. The scintigraphic study revealed homogenous uptake by the graft and an elimination speed of the hepatobiliary agent similar to that of the native liver. CONCLUSIONS: An heterogenous echostructure of the graft provided a sign of poor prognosis indicating necrosis in the same way as heterogenous uptake or nonuptake of radioisotope upon scintigraphy. Scintigraphy is a good method to evaluate biliary function and bile elimination. In an AHLT-PVA, the main ultrasound findings derived from arterialization were dilation of the portal system and portal flow with arterial spiculations.

Carcinoma basocelular metastásico en la región parotídea: un nuevo caso / Basal cell carcinoma metastatic to the parotid area: case report

El carcinoma basocelular es la tumoración cutánea maligna más frecuente. Junto con el carcinoma espinocelular su localización habitual es a nivel de cabeza y cuello y a diferencia de éste la tasa de metástasis regionales es mucho más baja. Presentamos el caso de una mujer de 85 años con un carcinoma basocelular a nivel del pabellón auricular derecho, que inicialmente se trató mediante extirpación y cierre. A los 2 años presentó recidiva local en la zona inferior del pabellón auricular y en la exploración física se apreció una tumoración dura a nivel submandibular derecho. Se realizó punción aspiración con aguja fina (PAAF) que fue positiva para metástasis de carcinoma basocelular. La Tomografía Axial Computerizada (TAC) mostraba una masa única en la región submandibular no adherida a la mandíbula. El tratamiento consistió en extirpación de la recidiva local y parotidectomía superficial más vaciamiento cervical funcional del lado derecho. La paciente se negó a realizar tratamiento con radioterapia complementaria. En la actualidad la paciente está viva y realiza revisiones periódicas (AU)

Basal cell carcinoma is the most common cutaneous malignancy. As the scamous cell carcinoma its first location is in head and neck, but the rate of regional metastases is much lower. ;;We present the case of an 85-year-old woman with a basal cell carcinoma located on the ear. ;;She was first treated by local excision and direct suture. Two years later presented a local recurrence in the lower part of the ear. At this time a physical neck exam revealed a submandibular node. ;;Fine needle aspiration was positive for basal cell carcinoma metastases, and a Computed Tomography (CT) showed a single mass in the submandibular region not in contact with bone. ;;Treatment consisted on a wide local excision, superficial parotidectomy and ipsilateral functional neck dissection. ;;The patient refused postoperative radiotherapy treatment. ;;At this moment the woman is alive and under periodical revision (AU)

Evaluación de las motivaciones y actitudes en pacientes diabéticos tipo 1 y 2 mediante escala DAS-3SP / Evaluation of variables that influence in the motivation of the diabetic patients type 1 and 2 using DAS-3 scale

Objetivo: conocer las variables que influyen en la motivación de los pacientes diabéticos 1 y 2, para brindar un mejor control y adherencia al tratamiento. Material y métodos: estudio descriptivo mediante encuesta Das-3 a pacientes diabéticos tipo 1 y 2. Resultados: distribución por sexo similar en ambos grupos de pacientes, con un promedio de edad de 29,5 años (DM1) y 59,1 años (DM2). El nivel educacional fue mayor en el grupo de pacientes con DM1, p<0,05. La percepción de gravedad de enfermedad y valoración del control estricto fue mayor en los pacientes diabéticos tipo 1 con diferencias significativas (p<0,05). Conclusión: es necesario que la información que proporcionan los profesionales se ajuste a las necesidades de los pacientes en un lenguaje claro y adaptado a la realidad. La comunicación es la herramienta primordial para favorecer la adherencia y mejorar la calidad asistencial.

Caso clínico: utilización clínica de aloinjerto de piel humana con pomada de tacrolimus / Case report: clinical use of skin human allograft with topical tacrolimus ointment

Exponemos el caso de una mujer de 52 años que presenta dos úlceras en su pierna derecha secundarias a traumatismo. La paciente había sufrido un transplante renal y recibía tratamiento inmunosupresor por vía sistémica: ciclosporina y corticoides. Debido a su extrema gravedad se rechazó el tratamiento quirúrgico de las úlceras, por lo que tras revisar la literatura decidimos realizar la cobertura de las mismas con aloinjertos de piel criopreservada más pomada de Tacrolimus al 0.3%. El injerto de la úlcera de mayor tamaño se rechazó de forma parcial a las dos semanas, siendo necesarios cultivos de queratinocitos hasta lograr una epitelización total. Sin embargo, en la úlcera de menor tamaño el aloinjerto no fue rechazado, obteniéndose un 100% de supervivencia. En la actualidad la paciente lleva 18 meses de evolución sin ningún signo de rechazo (AU)

We report a case of a 52 year-old-woman with two traumatic skin ulcers on his right leg. The patient was kidney grafted with immunosuppressor sistemic treatment: ciclosporine and corticoids. This patient was critical, so surgical treatment was refused. After reviewing literature we decided to cover the ulcers with cryopreserved allograft skin with Tacrolimus ointment in 0.3 % strength. The big ulcer skin graft was rejected 2 weeks later, being necessary keratinocytes cultures to heal. But in the small ulcer, the allograft suffered no rejection at all, with a 100% survival. At this moment the patient is 18 months postoperative with no signs of allograft rejection (AU)

Glomangiosarcoma of the hypothenar eminence: a case report.

Glomangiosarcoma is an exceptionally rare soft tissue tumor. It tends to appear as a painful nodule located in the subcutaneous tissue. There are only two cases described on the hand before instead of the benign glomus tumor is usually located at this level. Histochemically the glomangiosarcoma shows features that remind a benign glomus tumor, except for the malignant glomus tumor arising de novo. This neoplasm is considered a low grade malignant tumor with tendency to local recurrence, though metastasis have been reported. We report the case of a 36 year-old -woman with a glomangiosarcoma in a glomus tumor in the hypotenar eminence. The treatment was a local complete excision and there was no signs of recurrence after 18 months.

Prevention of hyperacute rejection in a model of orthotopic liver xenotransplantation from pig to baboon using polytransgenic pig livers (CD55, CD59, and H-transferase).

INTRODUCTION: The search for alternative sources for transplant organs leads us to the search for animals as an inexhaustible source of organs. The objective of this study was to analyze whether livers from polytransgenic pigs expressing the human complement regulatory proteins CD55 (hDAF), CD59, and alfa alpha1,2-fucosyltransferase (H-transferase), protected against hyperacute rejection after orthotopic liver xenotransplantation to a baboon and also to study pig liver function in a nonhuman primate. MATERIALS AND METHODS: Nine liver transplants from pig to baboon were divided into two groups: a control group (n = 4) of genetically unmodified pigs and an experimental group (n = 5) of pigs transgenic for CD55, CD59, and H-transferase as donors. All the donating piglets obtained through hysterectomy were maintained in specific pathogen-free conditions. The selection of transgenic pig donors followed demonstration of transgene expression using monoclonal antibodies (antiCD55, antiCD59) and immunohistological studies on liver biopsies. RESULTS: All animals in the control group developed hyperacute rejection with survival rates less than 16 hours without function of transplanted livers. In the experimental group none of the animals suffered hyperacute rejection. Survival in this group was between 13 and 24 hours. The livers were functional, producing bile and maintaining above 35% prothrombin activity. Only in one case was there primary dysfunction of the xenograft. CONCLUSION: Polytransgenic livers for complement regulatory proteins prevent hyperacute rejection when xenotransplanted into a baboon.

[The stability of solid food labeled with different radiopharmaceuticals for studying gastric emptying]. / Estabilidad de alimento sólido marcado con diferentes radiofármacos para vaciamiento gástrico.

OBJECTIVE: Sulfur colloid 99mTc-SC, the radiopharmaceutical of choice for solid gastric emptying studies, is not available in our country. It has led us to assess the solid binding stability of seven alternative radiopharmaceuticals that could present adequate fixation to it a priori. MATERIALS AND METHOD: The stability of labelled solid food with seven colloidal 99mTc-radiopharmaceuticals of different sizes and nature (MAA, tin colloid, rhenium sulphide macrocolloid, albumin microcolloid, sulfur nanocolloid, albumin nanocolloid and rhenium sulfur nanocolloid) has been studied by measuring their dissociated activity after two hours digestion in simulated gastric fluid (kept 120' in agitation, in HCl 0.1 M at 37). The survey also assesses radiopharmaceutical labelling stability after two hours digestion in identical conditions by measuring their radiochemical purity in ITLC. RESULTS: In these conditions, MAA, rhenium sulphide macrocolloid, albumin microcolloid and albumin microcolloid present the best behaviour, with an activity linked to food over 90 % of the previously fixed activity. CONCLUSIONS: According to the results, there is no relationship between the radiopharmaceutical size and nature and the stability of its binding to the solid food. Because rhenium sulphide macrocolloid is no longer manufactured and the other three radiopharmaceuticals which have a binding stability to the solid food over 90 % do not include digestive explorations amongst their indications, nowadays, there is a serious legal limitation to carry out this type of studies in our country.

Estabilidad de alimento sólido marcado con diferentes radiofármacos para vaciamiento gástrico / The stability of labeled solid food with different radiopharmaceutical for gastric emptying

Objetivo: El azufre coloidal 99m Tc-SC radiofármaco de elección para estudios de vaciamiento gástrico de sólidos no está disponible en nuestro país. Ello nos ha llevado a valorar la estabilidad de unión a alimento sólido de siete radiofármacos que podrían presentar a priori adecuada fijación al mismo. Material y método: Hemos estudiado la estabilidad de unión a alimento sólido en tortilla de siete radiofármacos marcados con 99mTc(MAA, estaño coloidal, macro y nanocoloide de sulfuro de renio, micro y nanocoloide de albúmina y nanocoloide de azufre) mediante medida de la actividad disociada del mismo tras dos horas de digestión en medio gástrico simulado (120' en agitación a 37°, en HCl 0,1 M). Asimismo, y en idénticas condiciones, hemos determinado su estabilidad de marcaje por medida de su pureza radioquímica, obtenida por ITLC. Resultados: En estas condiciones los MAA, el macrocoloide de sulfuro de renio, el microcoloide de albúmina y el nanocoloide de albúmina presentan el mejor comportamiento, con una actividad ligada a alimento superior al 90 por ciento de la fijada inicialmente. Conclusiones: De los resultados obtenidos no se ha podido establecer ninguna relación entre tamaño o composición del radiofármaco y la estabilidad de su unión al sólido. Dado que el sulfuro de renio ha suspendido recientemente su producción y los tres radiofármacos restantes, con estabilidad de unión al alimento sólido superior al 90 por ciento, no incluyen las exploraciones digestivas entre sus indicaciones, existe actualmente en nuestro país una considerable limitación legal para realizar estudios de esta naturaleza (AU)

Tumores Oseos Benignos en Cirugía de Mano / Bone tumors in hand surgery

Los tumores de origen óseo a nivel de la mano son bastante frecuentes. El propósito de este trabajo es exponer nuestra experiencia en el diagnóstico y tratamiento de los mismos. Se presenta una serie de 73 pacientes con el diagnóstico de tumores de origen óseo de naturaleza benigna localizados en la mano y los dedos, en el periodo de tiempo comprendido entre los años 1985 y 2000, ambos inclusive (AU)

Bone tumors are relatively common at hand. The purpose of this arride is to report our experience in the diagnosis and treatment of those tumors.We present 73 cases ofbenign bone rumors localizated at hand and fingers over the period from 1985 to 2000 ( both years included) (AU)

Effects of rolipram, pimobendan and zaprinast on ischaemia-induced dysrhythmias and on ventricular cyclic nucleotide content in the anaesthetized rat.

BACKGROUND AND OBJECTIVE: This study was designed to compare the haemodynamic, electrophysiological and pharmacodynamic effects of three selective inhibitors of the different isoenzyme forms of phosphodiesterase (PDE) on ischaemia-induced dysrhythmias in the anaesthetized rat. The drugs used were pimobendan, a selective PDE III inhibitor, rolipram, a selective PDE IV inhibitor, and zaprinast, a selective PDE V inhibitor. METHODS: The coronary artery was occluded 15 min after commencing drug administration, and myocardial ischaemia was maintained for 30 min during which the heart rate and mean arterial pressure were recorded. cAMP and cGMP were determined by radioimmunoassay. RESULTS: Pretreatment with rolipram decreased the duration of ventricular tachycardia without any change in the incidences of dysrhythmias or the mortality rate. This drug did not modify ventricular content of adenosine 3',5'-cyclic monophosphate (cAMP) or guanosine 3',5'-cyclic monophosphate (cGMP). Pimobendan (1 mg kg(-1) + 0.1 mg kg(-1) min) decreased the duration of ventricular tachycardia. This dose of pimobendan and zaprinast (1 mg kg(-1) + 0.1 mg kg(-1) min(-1)) increased the incidence rate of ventricular fibrillation following coronary artery ligation and the mortality rate. Moreover, both drugs increased cGMP in the ventricle. CONCLUSIONS: The results demonstrated that pimobendan and zaprinast increased the incidence of dysrhythmias and the mortality rate, which was accompanied by an increase in the ventricular content of cGMP. Rolipram decreased the duration of ventricular tachycardia without a change in the cyclic nucleotide content or in the mortality rate.

Vacunaciones en atención primaria: nuevos aspectos de una vieja actividad / Primary care vaccination: new aspects of an old activity

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